Lids/Lashes/Orbit Flashcards
Dermatochalasis
Cause: Loose skin with age
Signs/Symptoms: Reduced superior visual fields
Tx: Blepharoplasty
Ectropion
Outward rolling of lid
Cause: Age, trauma, Bell’s Palsy (unilateral CNVII -> orbicularis -> palpebral portion -> muscle of Riolan)
Signs: Inferior exposure keratopathy
Tx
- Surgery to tighten lateral tarsal strip
- Lubrication/bandage CLs for exposure keratopathy
Entropion
Inward rolling of the lid (overaction of palpebral orbicularis)
Cause: Usually structural changes with age
S/S: Epiphora, Exposure Keratopathy, Trichiasis
Tx:
- Fix with tape temporarily, then surgery
- Topical Ab, lubrication, bandage CL
Trichiasis
Misdirected eyelashes mechanically rubbing the globe
Cause: Idiopathic, trauma, inflammation
S/S: Irritation, FBS, SPK, abrasions, injection
Tx:
-Eyelash epilation
-Topical Abs if epithelial compromise
Blepharospasm
Idiopathic bilateral incontrollable contraction of orbicularis oculi and surrounding facial muscles (frontalis, corrugator, procerus)
Tx: Botox injections every 12 weeks
Bell’s Palsy
CNVII Lower Motor Neuron paralysis affecting ipsilateral half of face (idiopathic, neural inflammation, HSV). Acute onset, S/S develop over 24 hours.
S/S: Unilateral epiphora, dry eye, drooling, inability to close one eye (laghopthalmos bc of disruption of orbicularis oculi). CNVII -> facial muscles, eyelid closure, ocular and oral secretions
Tx:
-None, improves within 4-12 months of onset. If viral, oral antiviral. If inflammation, oral steroid.
-Lubrication and nighttime ointment from inf exposure keratopathy while sleeping
Xanthelasma
Creamy yellow plaques in superior nasal eyelids, in elderly patients or patients with hyperlipidemia.
Tx: Not necessary but can be excised for cosmesis..
Blepharitis
Staph infection of sebacous glands, anterior (Zeis & Moll) or posterior (Meibomian). Can also be due to Demodex which will have collarettes.
S/S: Flaking on eyelashes, red/inflamed lid margins, dry eye symptoms
Tx:
- 1st line: lid hygiene and hot compress
- Erythromycin
- Xdemvy drops for Demodex
Pediculosis/Phthiriasis
Eye lash infections of crab lice (suspect sexual abuse if in children)
S/S: spots of blood, eggs, itching and burning, positive preauricular lymphadenopathy
Tx:
- lice removal with forceps
- Erythromycin for two weeks to smother the lice
Hordeolum
Infection of sebacous glands, external (Zeis & Moll) or internal (Meibomian, risk for orbital celluitis)
S/S: associated pain and eyelid tenderness, white cap may be visible
Tx:
- Hot compress and massage
- Topical Ab ointment or topical Steroid-Ab ointment
- Can do oral antibiotics too
Chalazion
Sterile inflammation of sebaceous gland, no tenderness or redness. Suspect sebaceous gland carcinoma if it occurs in the same spot.
Tx:
- Hot compress and massage
- Biopsy/Incision & Cutterage
- IPL/RF therapy
- Steroid injection
Sebaceous Gland Carcinoma
MALIGNANT - Suspect with recurring chalazion in same location or chronic unilateral blepharitis. Women 50-70 most common. Aggressive, high mortality, high rates of metastasis.
S/S: yellow, hard tumour. May be associated with madarosis/poliosis/lymphadenopathy.
Tx: Full thickness excision with biopsy.
BASAL CELL CARCINOMA
MALIGNANT - Most common malignant eye tumour but rarely metastasizes (cell division occurs naturally in this layer too). Sun exposed areas of skin in older white patients. Proliferation of deepest layer of epithelium.
S/S: Pearly nodule initially that turns into rodent ulcer (central ulcerative telangiectasia). Non-pigmented, feeder vessels, slow-growing.
Tx: Full thickness excision with biopsy.
Actinic Keratosis
PRE-MALIGNANT LESION - Sun exposed areas of skin in older white patients. Most common precancerous lesion, precursor to Squamous Cell Carcinoma. Occurs in spinosum layer, more malignant because cells in this layer normally do not replicate.
S/S: scaly, round, erythematous lesion
Tx:
- Full thickness excision with Biopsy
- Cyrotherapy
Squamous Cell Carcinoma
MALIGNANT - Precursor is Actinic Keratosis. In Spinosum layer.
S/S: Scaly, erythematous, ulcerated plaque. Rapid growth.
Tx:
- Full thickness excision with Biopsy
- Cyrotherapy
Malignant Melanoma
MALIGNANT - Most lethal primary skin tumour.
S/S: Pigmented, elevated lesions with irregular borders. Remember ABCDE
A - Asymmetry
B - Border (blurry and/or jagged)
C - Colour (more than one within lesion)
D - Diameter >6mm
E - Evolution (sudden changes in size, shape, or colour)
Tx:
-Full thickness excision with biopsy
-Orbital Exenteration with neck dissection (removal of all the contents of the eye socket)
Capillary Hemangioma
BENIGN - Most common benign orbital tumour in children (Cavernous Hemangioma is most common in adults)
S/S: Usually 1st month of life, strawberry nevus with rapid growth, may cause amblyopia or induce astigmatism by pressing on the cornea
Tx: Will spontaneously resolve by age 10.
Contact Dermatitis
Patient touches allergen with their hands and then rubs their eyes
S/S: Crusting/flaking erythematous rash with possible edema
Tx:
-Avoid allergen
-Cold Compress
-Topical Steroid Cream
-IF rash is crusting/weeping, then Ab ointment
Ocular Rosacea
Autoimmune/idiopathic inflammatory disorder, acne with pustules that persists into adulthood. Predominantly in women, can be triggered by caffeine, stress, etc.
S/S: Telangiectasia, pustules, erythema. Possible dry eye or corneal neo, greater risk for recurrent chalazion
Tx:
-Oral tetra/doxycycline to treat systemic pathology (erythromycin if allergic)
-Topical steroids to treat inflammation
